Four-Component Recombinant Protein–Based Vaccine Effectiveness Against Serogroup B Meningococcal Disease in Italy
Authors: Lorenzo Lodi, Federica Barbati, Daniela Amicizia, Vincenzo Baldo, Anna Maria Barbui, Alessandro Bondi, Claudio Costantino, Liviana Da Dalt, Lorenza Ferrara, Francesca Fortunato, Valentina Guarnieri, Giancarlo Icardi, Giuseppe Indolfi, Domenico Martinelli, Marco Martini, Maria Moriondo, Francesco Nieddu, Diego G. Peroni, Rosa Prato, Silvia Ricci, Francesca Russo, Francesca Tirelli, Francesco Vitale, Shamez N. Ladhani, Chiara Azzari, Mario Palermo, Girolama Bosco, Rosanna Milisenna, Mario Cuccia, Franco Belbruno, Giulia Tarabini Castellani, Claudio D’Angelo, Giuseppe Ferrera, Lia Contrino, Gaspare Canzoneri, Onofrio Mongelli, Nehludoff Albano, Domenico Lagravinese, Riccardo Matera, Stefano Termite, Giovanni Iannucci, Alberto Fedele, Michele Conversano, Irene Amoruso, Tatjana Baldovin, Silvia Cocchio, Nicole Bonaccorso, Martina Sciortino, Arianna Conforto, Susanna Masiero, Daniela Lombardi, Elisa Di Maggio, Martina Meola, Silvia Boscia, Michele Tonon, Marzio Masini, Maria Francesca Piazza, Camilla Sticchi
Journal: JAMA Network Open (2023)

Importance Population-based data on the 4-component recombinant protein–based (4CMenB) vaccine effectiveness and reduction in incidence rate ratios (IRRs) are continuously needed to assess vaccine performance in the prevention of serogroup B invasive meningococcal disease (IMD). Objective To assess the effectiveness and reduction in IRRs associated with the 4CMenB vaccine in the pediatric population in 6 regions in Italy. Design, Setting, and Participants This retrospective cohort screening study and case-control study included data from children aged younger than 6 years in 6 highly populated Italian regions from January 1, 2006, to January 1, 2020. Participants included children younger than 6 years diagnosed with serogroup B IMD without predisposing factors. Data were collected from regional surveillance and vaccination registries and were analyzed from September 2021 to January 2022. Exposures Routine 4CMenB vaccination, per regional vaccination programs. Main Outcomes and Measures The main outcome was the effectiveness of the 4CMenB vaccine in the prevention of serogroup B IMD in the population of children aged younger than 6 years in 6 Italian regions. The percentages of vaccine effectiveness (VE) were obtained through the concomitant use of a screening method and a case-control study. Secondary outcomes were the comparison of effectiveness results obtained using the 2 different computational methods, the description of serogroup B IMD incidence rates, and reduction in IRRs before and after 4CMenB introduction, as a proxy for vaccine impact. Results The cohort screening study included a resident population of 587 561 children younger than 6 years in 3 regions with similar surveillance protocols, and the matched-case controls study assessed a resident population of 1 080 620 children younger than 6 years in 6 regions. Analyses found that 4CMenB VE in fully immunized children was 94.9% (95% CI, 83.1%-98.4%) using the screening method and 91.7% (95% CI, 24.4%-98.6%) using the case-control method. Overall reduction in IRR was 50%, reaching 70% in regions with early-start vaccination schedules. The case-control method involving 6 highly-populated Italian regions included 26 cases and 52 controls and found an estimated VE of 92.4% (95% CI, 67.6%-97.9%) in children old enough for the first vaccine dose and 95.6% (95% CI, 71.7%-99.1%) in fully immunized children. VE was more than 90% for partially immunized children. Even in regions where the first dose was administered at age 2 months, almost 20% of unvaccinated cases were among infants too young to receive the first 4CMenB dose. Conclusions and Relevance This screening cohort study and matched case-controls study found high effectiveness of 4CMenB vaccination and greater reduction in IRR for early-start vaccination schedules in preventing invasive serogroup B meningococcal disease. The high proportion of children too young to be vaccinated among unvaccinated cases suggests that starting the vaccination even earlier may prevent more cases. Screening and case-control methods provided similar estimates of VE: either method may be used in different study settings, but concomitant use can provide more robust estimates.